Provider Demographics
NPI:1598820524
Name:M KEN HEDRICK PC
Entity Type:Organization
Organization Name:M KEN HEDRICK PC
Other - Org Name:HEDRICK REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:864-275-0669
Mailing Address - Street 1:19 BROOKHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-1983
Mailing Address - Country:US
Mailing Address - Phone:864-275-0669
Mailing Address - Fax:864-976-3166
Practice Address - Street 1:201 E CURTIS ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2678
Practice Address - Country:US
Practice Address - Phone:864-275-0669
Practice Address - Fax:864-967-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7045Medicare PIN